No Cost Sharing for Contraceptives Under Preventive Services Rule

The debate just won’t settle over the controversial HHS Interim final rule from August 2011 that requires health insurance plans to cover certain preventive services for women, which includes birth control, well-woman visits, breastfeeding equipment assistance, and domestic violence screening according to the rule’s fact sheet. Following the release of the Interim final rule on August 3, 2011, both the pro-life and the pro-choice sides of the debate had strong opinions about the rule, according to a CNN.com article. The January 20, 2012 HHS news release reemphasizing the new requirements set to go into effect on August 1, 2012, again fueled the fire and has both sides speaking out about the rule.

The Interim final rule stems from provision of the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148) that requires group health insurers to provide coverage, without cost-sharing mechanisms such as co-payments, deductibles and co-insurance, for:

(1) evidence-based items and services that received a rating of A or B by the United States Preventive Services Task Force,

(2) immunizations for children, adolescents and adults that have in effect a recommendation by the Advisory Committee on Immunizations,

(3) evidence-informed preventive care and screenings for infants, children, and adolescents included in the Health Resources and Services Administration (HRSA) guidelines, and

(4) preventive care and screening for women as recommended in the HRSA guidelines, the latter of which is the current source of debate.

Public comments received regarding the Interim final rule spanned the spectrum from recommending that the HRSA guidelines regarding contraceptive services be applicable to all group health plans and health insurance issuers with no religious exemption to vilifying the requirement as contrary to the beliefs of religious employers. In the Interim final rule, however, HHS agreed to amend the requirement to allow HRSA the discretion to exempt religious organizations from the guidelines regarding contraception. Religious employers, for the purpose of the exemption, are defined as nonprofits that

(1) have the purpose of cultivating religious values,

(2) employ mainly people of similar religious beliefs, and

(3) serve people with similar religious beliefs.

Following the release of the rule in August, both sides of the abortion issue were outspoken regarding the contraceptive services requirement. (We also covered it briefly here.) The chairman of the Committee on Pro-Life Activities with the United States Conference of Catholic Bishops, Cardinal Daniel DiNardo, said that “the decision forces people to participate who may have moral or religious convictions that oppose contraception use,” according to a CNN.com article. In response to the Obama administration’s amendment to the rule that gives religious organizations that provide insurance to its employees the choice of whether to cover contraception, the same article cited that supporters claims that the coverage will help “millions of women who struggle to afford prescription birth control” and would go far to save the government money that would need to be spent on publicly funded births that result from unintended pregnancies.

In the January 20, 2012 news release, Kathleen Sebelius emphasized that the Interim final rule will provide women with health insurance coverage access to all preventive services, including all contraceptives approved by the FDA. Most health plans will be required to provide coverage for such services beginning August 1, 2012. A nonprofit organization that is not exempt from the requirement and that does not currently provide contraceptive coverage to employees under its insurance plan may be granted an additional year to comply, or by August 2, 2013, if they certify that they qualify for a delay. As Secretary Sebelius stated, “I believe this proposal strikes the appropriate balance between respecting religious freedom and increasing access to important preventive services.”

In response to the news release, various industry and religious groups have spoken out about the requirements. According to a story posted on Kaiser Health News (KHN), while churches may be exempt from the contraception coverage requirements, religious universities and hospitals are not, and, according to the story, the Conference on Catholic Bishops is promising a legal challenge to the requirement. As cited by the viewpoints raised by KHN, the familiar abortion debate was stirred up again. This likely isn’t the last we have heard about the preventive services rule.